- Add prenatal weight gain grid to all new OB charts.
- Include patient education brochure in all new OB education packets.
- Tell every pregnant woman how much weight gain is best for her.
- Display campaign posters in waiting and exam rooms.
- Post BMI cut-off chart by scale or in exam room.
ASK (1 minute)
- How much weight does the patient expect to gain with this pregnancy?
- How much weight has the patient gained in previous pregnancies?
- Has the patient had any problems with weight in the past (eating disorders,
overweight, difficulty gaining weight or losing weight after pregnancy)?
- How does the patient feel about gaining weight during her pregnancy?
ASSESS (1 minute)
- Assess BMI based on pre-pregnancy weight and height to determine
recommended weight gain range.
- Plot and track weight gain on Prenatal Weight Gain grid at each appointment.
- Determine if lack of food or poverty is contributing to inadequate weight gain.
- Does the patient suffer from severe nausea, vomiting, heartburn or
constipation preventing appropriate weight gain?
- Does the patient suffer from depression or have other high stress in her life
that is preventing adequate weight gain?
ADVISE (1 minute)
- Provide clear, strong, personalized weight gain information based on
the woman's BMI category.
- Discuss the appropriate rate of weight gain to optimize chances of
delivering a healthy weight baby while minimizing post-partum weight
retention.
- Provide personalized information linking behavior change to the positive
and negative birth outcomes.
- Statements such as "As your physician/nurse, I feel I should tell you"
for an advice message rather than "You should..." are subtle yet
powerful ways to convey respect for patient autonomy.
- Praise and reinforce appropriate weight gain.
ASSIST (3 minutes +)
- Discuss and use problem-solving methods for coping with nausea and other
gastrointestinal concerns.
- Provide appropriate information on nutrition and reassure that weight gain is
related to the baby’s growth and development, and is not just excess fat.
- Provide visual aids to assist with explaining aspects of weight gain.
ARRANGE (1 minute +)
- Assess weight gain at each visit, and encourage continued, steady gains.
- Refer patients to WIC, Food Stamps and food pantries as available.
- Refer patients to the social worker, dietitian or WIC, as available, for
assistance with stress and more intense nutritional counseling.
- Refer to a mental health professional and dietitian if an eating disorder
is suspected.
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